Protracted negotiations between Methodist Le Bonheur Healthcare and Blue Cross Blue Shield of Tennessee have left many Memphians wondering if their doctor could be an out-of-network provider when 2023 rolls around.

If the two groups do not reach an agreement on the rates Methodist charges and the fees Blue Cross pays, both for inpatient and outpatient care, it could result in tens of thousands ― likely more ― in the area being unable to access healthcare with Methodist providers or at a Methodist facility without a hefty out-of-pocket payment.

Both parties said the negotiations are ongoing and they hope to have a resolution by the end of the year.

The ripple effects of not reaching a deal by Dec. 31 would not only touch the tens of thousands whose employer-sponsored health insurance comes through Blue Cross, including 14,000 covered by two City of Memphis plans. It could also impact the many in the area covered by TennCare, including children.

More:Hospital safety: How did Memphis-area hospitals score in recent report?

Healthcare news:'God gave us the charge': Memphis couple emptied 401(k)s to fight COVID, and they're not done

Rep. Steve Cohen, D-Memphis, last week wrote a letter to Gov. Bill Lee asking him to help resolve the discussions. If an agreement is not reached, BlueCare and TennCare Select enrollees ― TennCare programs administered by Blue Cross Blue Shield ― could lose access to affordable treatment at facilities in the Methodist Le Bonheur Healthcare System. TennCare Select specifically covers children who are in foster care, have intellectual or developmental disabilities or disabilities qualifying them for supplemental security income.

As of November, 178,796 people in West Tennessee were covered by BlueCare, according to the state. Other insurance companies also partner with the state to administer coverage to other TennCare enrollees. It was not immediately clear how many of the 164,557 Shelby County children on the TennCare rolls would be impacted. Across the state, there were 53,732 individuals covered by TennCare Select as of November. It is not clear how many were in West Tennessee or Shelby County.

Cohen said he was particularly concerned about the impact on children with complex healthcare needs.

“The apparent impasse between BlueCross and Methodist Le Bonheur poses a serious risk to all TennCare recipients but especially for the children whose needs can only be met at Le Bonheur,” he wrote. “Surgeries are being (canceled), and parents are terrified that their children will no longer be able to receive the specialized care that Le Bonheur has provided throughout their children’s lives. The situation is completely unacceptable.”

Cohen asked Lee to get the parties together to hammer out an agreement and, if not possible, asked the governor to direct the Division of TennCare to make special arrangements with Le Bonheur Children’s Hospital for children covered by TennCare.

Amy Lawrence, director of communications for TennCare, said that if a deal is reached by next weekend, there will be no impact on BlueCare or TennCare Select recipients. If not, the department will work to avoid a lapse in insurance.

“TennCare health plans are required by contract to provide continuity of care and will work to transition care if an agreement is not signed,” Lawrence said.

Here’s what you need to know about the ongoing negotiations.

What happens if there’s no agreement?

If no new agreement is reached by the end of the year, Methodist has said it would ask the insurance provider for "an extension to minimize any disruption to our patients and their families." If that isn’t agreed to, those with Blue Cross Blue Shield as their primary insurance providers ― including the TennCare plans administered by the company ― would be treated as out-of-network patients.

While some insurance plans offer out-of-network benefits or reimbursement, seeing an out-of-network provider almost always results in much higher costs for the patient for everything from a standard checkup to an emergency room visit.

"Our members have the freedom to visit the health care facility of their choice, and they can choose to continue to seek care from Methodist Le Bonheur after Jan. 1 ― but they will pay more for that care," Blue Cross said. "Our members can continue to seek in-network care with Methodist through Dec. 31. If we can’t reach agreement by the new year, members will continue to have in-network access to the full range of quality care from other Memphis-area providers including Baptist Memorial Health Care system, St. Francis Hospital and Regional One Health."

The insurance company also emphasized that failure to reach an agreement would not impact providers who are part of Methodist Le Bonheur-affiliated physician groups. It would only apply to Methodist facilities, Blue Cross said.

More:Five Memphis healthcare workers charged with conspiracy, HIPAA violations

Healthcare:Serenity Recovery Centers in Memphis gets federal grant, will expand work

What is the argument about?

In response to questions from The Commercial Appeal and in dueling guest columns published in The CA, representatives of Methodist and Blue Cross found different ways to say the same thing: the issue is money.

Blue Cross said the Methodist system charges significantly higher rates than other facilities in the Memphis area and Le Bonheur Children’s Hospital, in particular, charges notably high rates. Methodist said Blue Cross asked the hospital system to slash rates by 40% and did not consider a counter-offer, despite the level of free care it provided for the communities it served.

Methodist declined to discuss the specifics of the negotiations with The CA but said its rates are fair.

“Memphis is a narrow network market where payors like Blue Cross, Cigna, United Healthcare and others negotiate rates based on covered lives working together to reduce costs while improving quality. Methodist Le Bonheur Healthcare has a long track record of providing the highest quality and safest care of any other health system in this area,” the system said in a statement.

Methodist representatives, while saying they would continue to negotiate with Blue Cross, also encouraged people to “reach out to your human resources department and tell them you want to remain in the MLH network by switching to CIGNA, United Healthcare or other payors that pass their savings to you.”

Blue Cross said Methodist's most recent counter offer "fails to deliver savings that would more immediately support affordable coverage."

"Methodist Le Bonheur Healthcare charges us significantly higher rates than other Memphis-area facilities, which is ultimately unfair to our members. We’re simply asking Methodist to accept fair market rates in line with the wider market in Memphis," the insurance company said.

Corinne S Kennedy covers economic development and healthcare for The Commercial Appeal. She can be reached via email at Corinne.Kennedy@CommercialAppeal.com

This article originally appeared on Memphis Commercial Appeal: Blue Cross, Methodist continue to negotiate as Dec. 31 deadline looms